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The International Journal of Psychosocial Rehabilitation

Psychosocial Correlates in Adolescent Children

of Alcoholics-Implications for Intervention
(A Study From India)

Selwyn Stanley, M.A (SW); Ph.D.

Lecturer, Faculty of Health & Social Work
School of Psychosocial Studies, University of Plymouth; UK.

C. Vanitha, MSW
Psychiatric Social Worker
National Institute of Mental Health and Neuro Sciences
Bangalore, INDIA.

Stanley S., Vanitha C. (2008). Psychosocial Correlates in Adolescent Children of AlcoholicsImplications for Intervention. International Journal of Psychosocial Rehabilitation. 12 (2), 67-80

Introduction: There has been an increasing focus on children of alcoholics particularly in the West seeking to understand
the impact of parental alcoholism on their psychosocial functioning. Indian literature from this perspective is scanty and
there is a need for more comprehensive investigation particularly with adolescent children of alcoholics (COAs).
Objectives: This comparative study investigated the manifestation of self-esteem and adjustment in a group of fifty
adolescent children of alcoholics (COAs) and a matched reference group of adolescent children of non-alcoholics
(nCOAs). MATERIAL & METHOD: The Self esteem Index (Mac Kinnon, 1981) and Adjustment Inventory (Srivatsa and
Tiwari, 1972) were the instruments administered. An ex-post facto research design was used. Chi square, t-tests and Karl
Pearsons correlation coefficients were computed using SPSS for analysis.
Findings: The data revealed lower self-esteem and poor adjustment in all domains studied, in the adolescent COAs than
the controls. These deficits can be attributed to the increased stress and vitiated alcohol complicated domestic environment
of the COAs.
Clinical Implications: This study makes a strong case for psychosocial intervention with COAs who are otherwise
neglected in conventional de-addiction programmes in India.
Key Words: Adolescent Children of Alcoholics, Self-esteem, Adjustment.

There is a vast body of literature both in India and the West devoted to understanding the marital
dynamics involved in alcoholism and ascertaining the deleterious impact that alcoholism could
have on the personality and functioning of the spouse. Traits such as neuroticism, higher anxiety
levels, depression, low self-esteem and communication apprehension have been reported in wives
of alcoholics and attributed to the intense stress and trauma experienced by her in the vitiated
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domestic environment that she lives in (e.g. Stanley, 2001; Kutty and Sharma, 1988; Rao and
Kuruvilla, 1991). Higher levels of marital conflict and aggression have been also documented in
couples with an alcoholic spouse when compared to marital relationships which were not
complicated by alcohol (Stanley, 2006; Stanley & Anitha, 2007). Of late there has been an
increasing focus on children of alcoholics seeking to understand the adverse impact of parental
alcoholism on their growth and psychosocial functioning. Indian literature from this perspective is
scanty and there is a need for more comprehensive investigation to explore the consequences of
parental alcoholism particularly on adolescent children.
Adolescence has been globally accepted to be a period of turbulence and a significant
developmental milestone. Parental alcoholism could further compound and create a not so
conducive domestic environment significantly impacting the adjustment and personality of the
adolescent as he tries to come to grips with this tumultuous phase in his developmental career.
There is strong evidence to suggest that family dysfunction during childhood can negatively
influence later life experiences and adjustment (Werner and Broida, 1991). Drinking behavior may
interrupt normal family tasks, cause conflict and demand adjustive and adaptive responses from
family members who do not know how to appropriately respond. In brief, alcoholism creates a
series of escalating crises in family structure and function, which may bring the family to a system
crisis. As a result, the members may develop dysfunctional coping behaviors observes Ranganathan
(2004). Marital conflict and a lack of coping mechanisms were more frequent in these families and
children of alcoholic (COAs) fathers represent a group at risk for the early onset of psychiatric
problems observe Furtado et al. (2002).
Roosa et al. (1990), report that COA status was related to higher levels of negative and lower levels
of positive events. Hall and Webster (2002) found that adult COAs had more self-reported stress
and more difficulty initiating the use of mediating factors in response to life events. More COAs
than comparison offspring were experiencing serious problems in the areas of drinking, personality
and psychopathology (Casas-Gil and Navarro-Guzman, 2002) and Harter (2000), notes that adult
COAs appear at increased risk for a variety of negative outcomes, including substance abuse,
antisocial or under-controlled behaviors, depressive symptoms and anxiety disorders.
Sher et al. (1991), found that COAs reported more alcohol and drug problems, had stronger alcohol
expectancies, higher levels of behavioural under-control and neuroticism, and more psychiatric
distress in relation to nCOAs. Bird and Canino (1991), also found that children of alcoholics when
compared to those of non-alcoholics manifested higher levels of behavioural under control, more
neuroticism and greater psychiatric distress. Hall et al. (1994), report that adult COAs had lower
life satisfaction scores and significantly lower levels of locus of control than nCOAs. Their
academic performance is relatively poor (Miller and Krop, 1985) and Casas-Gil and NavarroGuzman (2002) have identified five variables on which performance by children of alcoholic
parents was poorer: intelligence, repeating a grade, low academic performance, skipping school
days, and dropping out of school.
The dysfunctional family environment created due to the presence of parental alcoholism has been
the focus of several investigations. A recent study by Kelley et al. (2007), reveals that adult children
of alcoholics reported more parentification, instrumental caregiving, emotional caregiving, and past
unfairness in their families of origin as compared to children of alcoholics. Williams and Corrigan
(1992), comment that growing up in a household with alcoholic parents is more likely to produce
emotional disorders, increases the childs risk of health problems, physical abuse and neglect. The
single most potent risk factor is their parent's substance-abusing behaviour and this can place
children of substance abusers at biologic, psychological, and environmental risk (Johnson and Leff,

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1999). Menees and Segrin (2000) observe that COAs are characterised as an at risk population
because of the dysfunctional family environment that disrupts their psychosocial development.
They often lack guidance and positive role modelling and live in an atmosphere of stress and family
conflict. Obot and Anthony (2004), found evidence to favour the hypothesis that adolescent
children living with an alcohol dependent parent have more delinquency problems than other
adolescents. Mylant et al. (2002) found that adolescent COAs scored significantly lower on all
psychosocial factors of family/personal strengths and school bonding and significantly higher on all
factors of at-risk temperament, feelings, thoughts, and behaviours than non-COAs and that they
were at risk for depression, suicide, eating disorders, chemical dependency, and teen pregnancy.
Hart et al. (2003) interpreted their results as providing partial and preliminary support for the
contention that living in an alcoholic environment during childhood and adolescence plays a role in
the manifestation of serious medical problems in adulthood. Findings from a longitudinal study by
Andreas & OFarrell (2007) show that fathers heavy drinking patterns and childrens psychosocial
problems appear to be closely related to one another over time, waxing and waning in meaningful
patterns, such that childrens adjustment was improved during times of parental alleviated drinking
and was worsened during times of parental exacerbated drinking. Their results thus add additional
support to the hypotheses of causal linkages between problematic parental and problematic child
It is well established that children of problem drinkers have an increased risk of developing mental
health problems, not only during childhood but also when they grow up into adolescents and adults
observe Cuijpers et al (2006). Children of alcoholic fathers are at high risk for psychopathology and
gender-related differences also seem to exist contend Furtado et al. (2006). Depression and anxiety
are recurring themes in the literature on COAs (e.g. Callan and Jackson, 1986; Williams and
Corrigan, 1992; Steinhausen, 1995; Kelley, 1996; Deborah,1997) However, Reich et al. (1993),
report that though children of alcoholics exhibit high rates of psychopathology and may be at risk
specifically for oppositional and conduct disorders, they may be not so for depression. Behavioral
problems in adolescence have been shown to be associated with the presence of a positive family
history of alcoholism and negative parenting practices (Barnow et al., 2004). Jacob and Windle
(2000) are of the view that risks for COAs might relate specifically to parental alcoholism and its
impact on offspring development and not to the combined effects of various parental
psychopathologies and/or extreme forms of family instability. Exposure to marital conflict is
associated with childrens adjustment problems, including internalization and externalization
(Cummings et al., 2000) and the results of Keller et al. (2005) indicate that problem drinking may
harm children through its association with marital and parenting difficulties.
However, there is a contention within the alcoholism literature pertaining to children of alcoholics
that holds that they manifest no significant differences in terms of psychopathology or other
behavioural and personality deficits when compared to children of non-alcoholics. Segrin and
Menees (1996), opine that children may exhibit undisturbed psychosocial functioning despite
having an alcoholic parent and found no differences between adult children of alcoholics and
controls. Baker and Stephenson (1995), suggest that parental alcoholism does not necessarily result
in personality differences in adult children. Morey (1999), found that COAs and nCOAs
demonstrate no significant differences on measures of social support and shame while Reich et al.
(1993), report few differences between children of alcoholics and controls with respect to
self-esteem and achievement tests. Harter (2000) observes that there is little empirical support for
"adult COA syndromes" described in the clinical literature since the reported outcomes in them are
neither uniformly observed nor are specific to them. He contends that co-morbid parental
pathology, childhood abuse, family dysfunction, and other childhood stressors may contribute to or
produce similar outcomes.

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The brief review of the literature in the field reveals that while a lot of investigations have been
carried out with adult children of alcoholics, those with a specific focus on adolescent children are
not many. Further there is a dearth of exploration carried out on this issue in the Indian sociocultural context. This investigation was carried out against this background primarily from the
stress perspective associated with co-dependency, which hypothesizes that the heightened stress of
living in an alcohol complicated family environment could have adverse consequences on the
personality traits of adolescent children and manifest deficits in their psychosocial functioning.

To study and compare the self-esteem and adjustment in adolescent children of alcoholics
(COAs) and those of non-alcoholics (nCOAs).
To bring out the association if any between socio-demographic factors and the subject
dimensions studied.
To study the relationship if any among the subject dimensions.
To discuss implications for therapeutic intervention with adolescent COAs and their families
in the light of the results obtained.

Material and Methodology

Sample and Selection Procedure
Study Group
The study group consisted of 50 respondents whose fathers were receiving de-addiction treatment at
a private psychiatric hospital in Tiruchirappalli, India. Only adolescents between the age group of
13 and 18 years and who were residents of Tiruchirappalli were included in the sample. Their father
was registered for in-patient treatment after being diagnosed by the psychiatrist according to
Children of relapsed or recovering alcoholics visiting the de-addiction centre for follow-up services
were excluded.

Reference Group
50 nCOAs were identified from the schools of the study group respondents through their teachers.
A child was included in the reference group only if the father did not have a known drinking habit
and if the father scored less than seven (indicating non-alcoholic status) on the AUDIT (Alcohol
Use Disorders Identification Test; Babor et al., 1983) and if the child had no known history of
psychiatric illness. The two groups of respondents thus identified were comparable and matched on
the following variables (Table I):
S. No





t = 0.78







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P > 0.05

Birth Order



t =1.18




P > 0.05



t =0.306



P > 0.05



(Rupees per month)

* df = 98

The choice of same school respondents as the COAs also ensured a near homogenous socioeconomic profile for both groups. Their socio-demographic profile is presented in Table No. II and
the chi-square values indicate that the difference between the two groups is not significant and that
they are also comparable on the variables tabulated.


















2 =0.367

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Type of













Govt employee








Self employed

7 (14)














2 =3.407

2 =2.613
2 =1.810

2 =3.241

Figures in parantheses are percentages

*n=50, **p > 0.05

Research Design
This is a comparative study based on the presumption that the effect if any, of living with an
alcoholic (study group) or non-alcoholic (reference group) father would have already manifested
itself on both groups of respondents. The groups being matched on key socio-demographic
variables, the study is only an attempt to determine and compare the levels of self-esteem, and
adjustment manifested in these children at the point of data collection. This quasi-experimental
study thus uses an ex-post facto research design.

Tools of Data Collection

1. Self Esteem Index (SEI, Mac Kinnon, 1981) assesses an individuals perception of himself
his potential, worth and competence. It is a twenty-five item five point scale with responses
ranging from strongly agree to strongly disagree and has been widely used for research
in India in a variety of settings.
2. Adjustment Inventory (Srivatsa and Tiwari, 1972)
Adjustment inventory is an 80 item, two point scale with yes or no responses and measures
four dimensions of adjustment namely:
Home adjustment, Educational adjustment, Emotional and Social adjustment.
3. Self Prepared Interview Schedule to elicit information pertaining to socio-demographic
background and fathers drinking.

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Perception of Father's Drinking

Forty per cent of the COAs reported daily drinking by their father while forty two per cent said it
was on alternate days, the remaining were not sure of the frequency of drinking.
Regarding the duration of drinking, forty per cent said it was up to three years with the remaining
respondents mentioning that it was between three and ten years.
With regard to the behaviour of the father when intoxicated, fifty four per cent said that he became
more silent than usual, twenty six per cent said that he became boisterous and shouted at others
while the remaining twenty per cent expressed that he scolds and beats up the family


------------------------------------- SIGNIFICANCE
Alcoholics *
Non-alcoholiCS *
t =11.41
p <0.01


t =12.21
p <0.01



t = 10.29
p <0.01



t =4.95
p <0.01




t = 8.70
p <0.01
*n = 50;
** df = 98

t = 7.85
p <0.01

Self Esteem
Data presented in Table No. III show that the two groups of respondents manifest a high statistically
significant difference on the scores of this dimension with the children of alcoholics obtaining a
lower mean score indicative of poorer self esteem than children of the reference group.
Further it was seen in this study that the self-esteem scores did not show any significant correlations
with the age of the child (r = 0.15, p > 0.05) or his birth order (r = 0.15, p > 0.05). However a
negative correlation was obtained between the self-esteem scores and the number of siblings of the
respondent child (r= - 0.30, p <0.01).

Adjustment Profile
The data in table III reveals that COAs have obtained lower mean scores on overall adjustment as
well as all its component sub-dimensions (Home Education, Emotional and Social adjustment) than
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the respondents of the reference group and that the difference between them is statistically

Self Esteem and Adjustment

The self-esteem scores showed a highly significant positive correlation with the overall adjustment
score (r= 0.68, p<0.01) and also with all its component sub-dimensions namely, home adjustment
(r= 0.65, p<0.01), education (r= 0.42, p<0.01) as well as emotional (r= 0.59, p< 0.001) and social
adjustment (r= 0.52, p<0.01). It is significant to observe that all the correlations are positive in
nature. Though a cause-effect relationship cannot be read into this finding, each dimension studied
can be expected to directly influence the other.

The low self-esteem scores obtained by the study group respondents according to Mac Kinnon
(1981), indicates feelings of unhappiness with oneself and feelings of not being competent. It
reflects a sense of alienation and feelings of meaninglessness and failure.
Cole et al. (1980), observe that emotional maturity manifests in high self-esteem and enhances
ones interpersonal ability. Thus the low self-esteem seen in COAs is indicative of poor emotional
maturity and may diminish their interpersonal competence. This perhaps is reflected in the poor
adjustment scores obtained by the COAs across several domains seen in this study.
The findings of this study do not agree with that of Churchill et al. (1990), who found no significant
relationship between parental alcoholism and self-esteem of their children. In contrast, the results
are congruent with that of Morey (1999), who reports that self-esteem ratings for COAs were
significantly lower in comparison to ratings for nCOAs. Domenico and Windle (1993) also observe
that ACOAs reported higher levels of depression and lower levels of self-esteem. In a recent study
Hussong and Chassin (2004), found that children of alcoholics showed a statistically significant
difference in their emotional and behavioural aspects such as shyness, insecurity and low
self-esteem. Williams and Corrigan (1992), observe that growing up in a household with alcoholic
parents is likely to produce low self- esteem and Harter (2000) has also reported low self esteem in
ACOAs. Drucker and Greco-Vigorito (2002) observe that five separate factors related to Negative
Self-concept, Acting-out. Somatic/Disturbed Symptoms, Mood, and Hopelessness and that
depressive symptoms displayed by children of substance abusers are related to self-concept and
The finding of poor adjustment across all domains studied in COAs is consistent with the literature
on this issue. Harter (2000), reports that COAs faced difficulties in family relationships, and
experienced generalized distress and maladjustment. Hall and Webster (2002) found that ACOA
had more symptoms of personal dysfunction than the control group while Casas-Gil and NavarroGuzman (2002) report that more COAs than comparison offspring were experiencing serious
problems in the areas of educational and social functioning. Sher et al. (1991) observe that COAs
also evidenced lower academic achievement and less verbal ability than nCOAs. Lower quality of
life scores in children of alcoholics has been reported in another study by Oravecz (2002).
Haugland (2003), also reports that children of alcohol abusing fathers were found to have more
adjustment problems compared to a general population sample. His findings further suggested that
child adjustment in families with paternal alcohol abuse is the result of an accumulation of risk
factors rather than the effects of the paternal alcohol abuse alone. Both general environmental risk
factors (psychological problems in the fathers, family climate, family health and conflicts) and
environmental factors related to the parental alcohol abuse (severity of the alcohol abuse, the child's

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level of exposure to the alcohol abuse, changes in routines and rituals due to drinking) were related
to child adjustment. Adult children of alcoholics have reported more parentification, instrumental
caregiving, emotional caregiving, and past unfairness in their families of origin as determined by
Kelly et al. (2006). Thus the alcohol complicated domestic environment of the COAs could account
for the deficits in self esteem and adjustment seen in them in this study and these findings are in
consonance with the bulk of the western literature on these issues.

Implications for Psychosocial Intervention

The findings of this study have definite implications for intervention in de-addiction settings. It
highlights the fact that any effective de-addiction programme must acknowledge the need of
adolescent children to overcome and deal with various deficits in their psychosocial functioning.
The involvement of children in most de-addiction programmes in India is often peripheral if not
totally non-existent. De-addiction counsellors tend to concentrate more on the alcoholic in enabling
him overcome his psychological problems and in preparing him to lead a life without alcohol.
While the spouse is frequently involved for marital therapy, conflict resolution and antabuse
compliance, the therapeutic needs of children trapped in such families are most often
It is therefore important that the therapeutic needs of these children are addressed through
individual psychotherapy and other supportive therapies by providing an opportunity for ventilation
of feelings and integrating elements that will boost their self esteem and promote their psychosocial
adjustment in deficient areas. Normal difficulties and dilemmas associated with adolescence in
general could be worked through in these sessions besides focusing on issues pertaining to parental
alcoholism. A study from Korea reports that stress management program helps children of
alcoholics by enhancing self-esteem, providing information about alcohol, and improving
emotional and problem focused coping abilities, eventually enhancing their mental health (Yang
and Lee, 2005). Hence stress management techniques and relaxation modalities could be an
important component of working with COAs.
There is evidence to indicate that children show a considerable improvement on various domains
when their alcoholic fathers undergo treatment. Andreas et al. (2006), have found that before their
fathers' treatment, COAs exhibited greater overall and clinical-level symptomatology than children
from a demographically matched comparison sample, but they improved significantly following
their fathers' treatment. An effective package to overcome alcoholism should go beyond routine
pharmacotherapy and individual psychotherapy for patients. A wholistic intervention package must
involve other therapeutic adjuncts such as family therapy, couples therapy for not only the spouse
but also the COAs. O'Farrell and Fals-Stewart (2002), have advocated Behavioural Couples
Therapy (BCT) since it has been found to reduce social costs and domestic violence and showed
indirect benefits for the couple's children, and so BCT ought to be expanded to include family
members other than spouses, particularly the COAs. O'Farrell and Feehan (1999), note that BCT
with alcoholics and remission after individual alcoholism treatment have been associated with
improved family functioning in a variety of domains, including reduced family stressors; improved
marital adjustment; reduced domestic violence and verbal conflict; reduced risk of separation and
divorce; improvement in important family processes related to cohesion, conflict and caring; and
reduced emotional distress in spouses. These family factors have been linked with child mental
health and psychosocial functioning in more general child developmental and psychopathology
studies. Gains for COAs will hence accrue if they are involved in family therapy sessions. This will
facilitate opening up of communication channels and resolution of conflicts within the family and
thereby enhance the domestic and emotional adjustment of the children. Ranganathan, (2004),
observes that it is imperative to involve family members in treatment and that family therapy ought

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to be specific, with attainable therapeutic goals.

Children of alcoholic fathers represent a group at risk and are deserving of more attention in
prevention and early intervention (Furtado et al., 2002). Erblich et al. (2001) contend that since
COAs themselves are at particularly high risk for developing drinking problems, early intervention
efforts among COAs need to be initiated. Some of the guidelines that they stress include
emphasising the negative consequences of alcohol, developing in youth an increased sense of
responsibility for their own success, helping them to identify their talents, motivating them to
dedicate their lives to helping society rather than feeling their only purpose in life is to be
consumers, providing realistic appraisals and feedback for youth rather than graciously building up
their self-esteem, stressing multicultural competence in an ever-shrinking world, encouraging and
valuing education and skills training, increasing cooperative solutions to problems rather than
competitive or aggressive solutions, and increasing a sense of responsibility for others and caring
for others (Kumpfer and Hopkins, 1993). An affectionate father-child bond has a protective effect
observe Brook et al. (2003) and so an important focus during the course of family therapy is to
strengthen the intimacy between the parent and child, particularly with the alcoholic father since it
is likely that these bonds are already exacerbated due to the so called generation gap. It is also
necessary to confront parents with the effects of their behaviour (intervention, therapy) to develop
their possibilities to renovate their parenting functions, which is necessary for effective prevention
observes Wojcieszek (2003).
Nespor (2004) holds that prevention at the family level includes appropriate family monitoring and
rules, moderate and consistent family discipline and family conflict resolution. Kumpfer et al.
(2003), hold that since "substance abuse" is a "family disease" of lifestyle, effective family
strengthening prevention programs should be included in all comprehensive substance abuse
prevention activities. They advocate dissemination of five highly effective family strengthening
approaches (e.g., behavioural parent training, family skills training, in-home family support, brief
family therapy, and family education).
Currently, many COAs remain unidentified within schools and may not be receiving the
counselling services that they deserve and require. The family dysfunctionality of such children
places them at high risk for adverse academic, physiological, emotional, and social consequences
observe Lambie and Sias, (2005). It then becomes an important task for the school counsellor to
identify such children in distress and to provide them with supportive services besides intervention
with families to the extent possible. Knowledge of fathers' alcohol use and its time of onset may be
used to determine children who are at added risk of problematic alcohol use later in life and so
special guidance, support and treatment can be targeted to these families observe Seljamo et al
(2006). In the Indian scenario where the majority of schools do not have a professional counsellor,
this important task needs to be addressed by teachers who are in a position to identify such children.
While groups such as Alateen function for COAs in the West, such therapeutic self help groups
for COAs in the Indian setting are woefully lacking and must be initiated. The common
intervention foci for such groups should according to Emshoff and Anyan (1991), include
information on alcohol and alcoholism, the dynamics of alcoholic families, common social and
emotional reactions (e.g., embarrassment, loneliness, guilt, depression, anger), skill building (e.g.,
problem solving, communication, expression of feelings), coping strategies for living in an
alcoholic home, and general social and emotional support. Kuhns (1997), observes that both group
psychotherapy and self-help groups for COAs were effective in decreasing levels of depression
while Kingree and Thompson (2000), found that participation in the mutual help group promoted
perceived status benefits, which in turn led to reductions in depression and substance use. The need
to strengthen the social support available to such children has been highlighted by Werner and

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Johnson (2004) whos data showed that individuals who coped effectively with the trauma of
growing up in an alcoholic family and who became competent adults relied on a significantly larger
number of sources of support in their childhood and youth than did the offspring of alcoholics with
coping problems.
Intervention with COAs must hence involve resolution of individualised issues pertaining to
adolescence as well as parental alcoholism. Elements to enhance their self esteem and adjustment
across various domains need to be consciously included besides involving them in family therapy
sessions. Strengthening their social support systems, fortifying familial bonds besides facilitating
their participation in self help groups comprising of other COAs, could go a long way in enhancing
their mental health. These efforts must be concurrently initiated along with other therapeutic
procedures that focus on the alcoholic per se.

This study has revealed that the majority of COAs manifest lower levels of self-esteem and a lesser
degree of adjustment than nCOAs. The two groups of respondents were matched on key sociodemographic variables and the alcoholism of the father of the study group subjects was a major
differentiating factor between the two. The author against this background is inclined to concur
with the proponents of the stress perspective on co-dependents of alcoholics as the data of this
study indicates that the stressful and vitiated domestic environment prevalent in alcohol
complicated familial relationships is responsible for the low self-esteem and deficient adjustment
seen in adolescent children of alcoholics. There is hence an imperative need for therapeutic
intervention with this population. The need of the hour is to develop programmes for COAs with a
strong focus on strengthening resilience in them and to inculcate desirable personality traits and
enhance their psychosocial functioning through appropriate psychotherapeutic procedures. This
study underscores the point that co-dependent adolescent children of alcoholics also merit
therapeutic intervention owing to the various deficits in psychosocial functioning manifested in

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